Original Research

Weighing the costs: Implementing the SLMTA programme in Zimbabwe using internal versus external facilitators

Edwin Shumba, Phoebe Nzombe, Absolom Mbinda, Raiva Simbi, Douglas Mangwanya, Peter H. Kilmarx, Elizabeth T. Luman, Sibongile N. Zimuto
African Journal of Laboratory Medicine | Vol 3, No 2 | a248 | DOI: https://doi.org/10.4102/ajlm.v3i2.248 | © 2014 Edwin Shumba, Phoebe Nzombe, Absolom Mbinda, Raiva Simbi, Douglas Mangwanya, Peter H. Kilmarx, Elizabeth T. Luman, Sibongile N. Zimuto | This work is licensed under CC Attribution 4.0
Submitted: 09 September 2014 | Published: 03 November 2014

About the author(s)

Edwin Shumba, Zimbabwe National Quality Assurance Programme (ZINQAP) Trust, Zimbabwe
Phoebe Nzombe, Zimbabwe National Quality Assurance Programme (ZINQAP) Trust, Zimbabwe
Absolom Mbinda, Zimbabwe National Quality Assurance Programme (ZINQAP) Trust, Zimbabwe
Raiva Simbi, Ministry of Health and Child Welfare (MoHCW), Zimbabwe
Douglas Mangwanya, Ministry of Health and Child Welfare (MoHCW), Zimbabwe
Peter H. Kilmarx, US Centers for Disease Control and Prevention (CDC), Zimbabwe
Elizabeth T. Luman, U.S. Centres for Disease Control and Prevention (CDC), United States
Sibongile N. Zimuto, Zimbabwe National Quality Assurance Programme (ZINQAP) Trust, Zimbabwe


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Abstract

Background: In 2010, the Zimbabwe Ministry of Health and Child Welfare (MoHCW) adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme as a tool for laboratory quality systems strengthening.

Objectives: To evaluate the financial costs of SLMTA implementation using two models (external facilitators; and internal local or MoHCW facilitators) from the perspective of the implementing partner and to estimate resources needed to scale up the programme nationally in all 10 provinces.

Methods: The average expenditure per laboratory was calculated based on accounting records; calculations included implementing partner expenses but excluded in-kind contributions and salaries of local facilitators and trainees. We also estimated theoretical financial costs, keeping all contextual variables constant across the two models. Resource needs for future national expansion were estimated based on a two-phase implementation plan, in which 12 laboratories in each of five provinces would implement SLMTA per phase; for the internal facilitator model, 20 facilitators would be trained at the beginning of each phase.

Results: The average expenditure to implement SLMTA in 11 laboratories using external facilitators was approximately US$5800 per laboratory; expenditure in 19 laboratories using internal facilitators was approximately $6000 per laboratory. The theoretical financial cost of implementing a 12-laboratory SLMTA cohort keeping all contextual variables constant would be approximately $58 000 using external facilitators; or $15 000 using internal facilitators, plus $86 000 to train 20 facilitators. The financial cost for subsequent SLMTA cohorts using the previously-trained internal facilitators would be approximately $15 000, yielding a break-even point of 2 cohorts, at $116 000 for either model. Estimated resources required for national implementation in 120 laboratories would therefore be $580 000 using external facilitators ($58 000 per province) and $322 000 using internal facilitators ($86 000 for facilitator training in each of two phases plus $15 000 for SLMTA implementation in each province).

Conclusion: Investing in training of internal facilitators will result in substantial savings over the scale-up of the programme. Our study provides information to assist policy makers to develop strategic plans for investing in laboratory strengthening.


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Crossref Citations

1. Maximising mentorship: Variations in laboratory mentorship models implemented in Zimbabwe
Phoebe Nzombe, Elizabeth T. Luman, Edwin Shumba, Douglas Mangwanya, Raiva Simbi, Peter H. Kilmarx, Sibongile N. Zimuto
African Journal of Laboratory Medicine  vol: 3  issue: 2  year: 2014  
doi: 10.4102/ajlm.v3i2.241